This Mentored Patient-Oriented Research Career Development Award will enhance my ability to achieve my long-term career goal of becoming an independent cardiovascular nurse researcher in the area of heart failure (HF). It will allow me to develop and test interventions to improve medication adherence and health outcomes in patients with HF, especially patients with low health literacy. Heart failure is a serious public problem. Up to 50% of patients are readmitted within six months of discharge for HF exacerbations. The natural history of HF can be modified by appropriate therapy but medication adherence is essential to realize this benefit. About 50% of HF patients now have sub-optimal medication adherence with serious consequences including frequent hospitalizations, enormous expense to individuals and society, and poor quality of life. Several interventions have led to improved medication adherence in patients with HF, but, their effects decreased after completion of the intervention. Thus, there is a need for a new approach. My mentoring team (Drs. Michael Pignone, Sandra Dunbar, Darren DeWalt, Carol Golin, and George Knafl) and I have formulated a comprehensive training program of workshops, short courses, and seminars, and a research project that will prepare me for a research career focusing on improving medication adherence in HF. In the proposed project of the K23 award, I will pilot test an integrated family-focused and literacy-sensitive intervention that has the potential to effectively improve medication adherence in patients with HF and enable patients to sustain the improvement. A total of 36 HF patients with sub-optimal medication adherence and their family members will be randomized to intervention or usual care groups. If the study demonstrates the feasibility and efficacy of a clinically practical, nurse-delivered, family-focused and literacy-sensitive intervention to improve medication adherence in patients with HF, the next step will be to develop a larger, more definitive test of the intervention. Interventions to improve medication adherence may decrease the risk of hospitalization and death among patients with HF who have sub-optimal medication adherence.